New medical billing codes now include ‘struck by an Orca,’ but how will they help most people?

The new International Classification of Diseases (ICD-10) codes, or classifications used by doctors and insurance companies for billing purposes, took effect Oct. 1, 2015, amid concerns about confusion and incorrect coding. There are thousands more ICD-10 billing codes as compared to the old ICD-9 system — the Centers for Disease Control and Prevention lists over 140,000 codes between procedures and diagnosis, compared to less than 18,000 under ICD-9.

The ICD system is effectively the worldwide common language for reporting and monitoring diseases, and the U.S. is lagging behind much of the world in adopting ICD-10. Part of the reason why health care providers are dragging their feet with implementation is that while the codes are useful on the back end of care for analysis and identifying potential improvements and cost reductions, they are a royal pain for the providers.

You may have had a good laugh at several articles compiling bizarre ICD-10 codes from which physicians have to choose. It is hard not to laugh at “struck by an Orca,” “sucked into a jet engine,” and our personal favorite, “burn due to water skis on fire.” Perhaps ICD-11 will have a code that covers “struck by a flaming Orca on water skis wearing a jet engine”!

It’s all very funny — until your doctor cannot find the best code description to cover your visit and the insurance company refuses to pay. The Workgroup for Electronic Data Interchange (WEDI) announced in August that, according to its readiness survey, approximately 25 percent of doctors would not be ready for the transition and another 25 percent were not sure they would be ready in time. Thus, up to half of America’s doctors may not be able to find the right code for your visit.

Who can blame them? Let’s take the example of an injury, which requires four different codes.

Injury — Information includes side of body, body part, whether it is the first visit or follow-up visit for that injury, or whether it is a subsequent injury caused by the first one, such as an infected wound. Note that “initial encounter” and “subsequent encounter” refer to seeing the doctor, not the injury. “Walked into lamppost, subsequent encounter” does not mean you ran into a lamppost twice.

Where did the injury take place — Seemingly straightforward, but not necessarily so. For example, in some codes you can find “bodies of water” but not “lake.” Phrasing is important, yet not obvious. The process can be frustratingly time consuming if you are a doctor already running behind on appointments, and patients are not likely to be sympathetic as to why you are running late.

What activity was taking place — Imagine how many ways this can be parsed. It’s easy to defer to “other” only to find an obscure code exists for that activity — such as Orca training.

Status — Are you a student, worker, volunteer, Orca Trainer… you get the idea.

It is not straightforward, nor is it easily searchable — in fact, it isn’t searchable at all as of this writing, at least in the sense of “searchable” we associate today with computer databases. Doctors may only have a huge reference book to use, with smaller “cheat sheets” for more common codes. It will take time for doctors to get used to the new codes and erroneous coding could have serious manifestations. Patients could end up being billed for services that are actually covered by insurance, and insurance may deny claims that are improperly coded.

Expect delays during the transition period, and be prepared for a battle with doctors and insurance companies as you deal with improperly coded services.

As a side note for ObamaCare haters, ICD-10 cannot be blamed on the Affordable Care Act (ACA). The ICD is an effort of the World Health Organization and not directly related to the ACA. Obviously, ObamaCare will use ICD-10 information — as will any healthcare and insurance system we use.

Don’t like ICD-10? All you have to do is wait until 2018, when ICD-11 rolls out to accommodate electronic medical records and other information systems. That will certainly make things smoother… won’t it?


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